Decades Later, Past Lifestyle Changes Still Pay Off

An 8-year study of diet and exercise intervention in older adults with diabetes has continued to show benefits for participants long after the intervention ended, researchers said at the Gerontological Society of America (GSA) 2026 Annual Scientific Meeting in National Harbor, Maryland.The original Look AHEAD (Action for Health in Diabetes) randomized controlled trial, started in the early 2000s, was halted in 2012 because of a lack of an effect on cardiovascular disease (CVD) morbidity and mortality, said Denise Houston, PhD, RD, professor of internal medicine and epidemiology and prevention at the Wake Forest University School of Medicine in Winston-Salem, North Carolina, who has led follow-up studies.But follow-on studies in the population have shown the lifestyle intervention brought other benefits, including a 3-year delay in the onset of frailty, improved gait speed, lower rates of obstructive sleep apnea, and less use of insulin and GLP-1 medications, Houston and colleagues found.“That primary outcome for CVD did not come to fruition, but so much else did,” said Kate Callahan, MD, professor of internal medicine and gerontology at the Wake Forest University School of Medicine, who sat on the panel presenting the studies. “It is so remarkable…that this study continues to generate so much data over time.”The original trial of 5145 participants aged 45-75 years with type 2 diabetes sought to determine whether an intensive lifestyle intervention would decrease rates of CVD and related mortality in adults with overweight or obesity. The program, beginning in 2004, included goals of 10% body weight loss through caloric restriction and physical activity for at least 175 minutes per week. A control group received basic support and education about diabetes.Data tracking of participants resumed for a 2-year period in 2013 and a 5-year period in 2015, and the data were used to produce observational cohort studies examining cognition and lifestyle outcomes. Additional studies on aging and sleep occurred from 2021 to 2025.In a secondary analysis of participants (n = 3723) who completed at least one physical performance assessment between years 12 and 16, intervention group participants showed better gait speed in a 400-m walk test and lower extremity performance, measured by repetitive rising from a chair. Grip strength was not significantly different. Mean weight loss remained significantly higher in the intervention group for 20 years of follow-up before results from both groups began converging, Houston said.“The intervention was successful in the remission of diabetes, reducing nephropathy and neuropathy, improving physical health-related quality of life and mobility, and decreasing disability life-years,” she said.The median time to developing frailty was 8 years for the control group and 11 years for the intervention group — a 3-year delay in onset. However, the benefits of the intervention waned after about 20 years.The intervention also appeared to have some effect on sleep apnea rates: Up to 43% of adults in the intervention group were diagnosed with sleep apnea compared to 53% of those in the control group. Nearly 8% of individuals in the control group required oxygen during sleep compared with 2.89% of those in the intervention group.In a subgroup of 3510 participants whose records were linked with Medicare data, lower use of insulin and GLP-1 medications was shown in the intervention group.Even though the intervention initially was suspended, it had “all of these long-term effects,” said Peter Huckfeldt, PhD, associate professor of healthcare administration leadership at the University of Minnesota School of Public Health in Minneapolis, who co-chaired the session at GSA.“It’s notable that the intervention ended [over] 10 years ago, and in this post-intervention period, you’re still seeing these benefits that sustained. The evidence points to the fact that lifestyle management can have really multifaceted impacts that sustain over many years,” he told Medscape Medical News.The Look AHEAD studies were funded by the National Institute on Aging and the National Institute of Diabetes and Digestive and Kidney Diseases. The speakers reported no relevant financial disclosures.Karen Blum is a freelance medical and science writer in the Baltimore area.